CMS Ramps Up RAC Program

AAFP Responds With Guide for Physicians

By News Staff
3/12/2009

CMS is moving forward with its Recovery Audit Contractors, or RAC, program, which seeks to recover Medicare overpayments to physicians and other providers. In response, the AAFP has compiled an online guide to help physicians better understand and cope with the program.

CMS was forced to postpone the program's launch last fall because of contractor bidding disputes, but it is now ready to implement the program. In response, 100 medical professional associations, including the AAFP, joined forces to request that CMS listen to physician concerns and adjust RAC rules accordingly.

In a March 9 letter to CMS Acting Administrator Charlene Frizzera, the associations requested that CMS

remove evaluation and management, or E/M, services from the list of physician services targeted for auditing;
limit RAC medical record requests to three in a 45-day period for solo practitioners;
raise the minimum claim amount to at least $100; and
require RAC program contractors to reimburse physicians for copies of requested medical records before starting RAC audits.

The letter also strongly urged CMS to step up its efforts to inform physicians about Medicare billing policies.

In addition, the AAFP's Practice Support Division has compiled a guide to the RAC program to help family physicians understand how the program may affect their practices. The guide, which is presented in an a question-and-answer format, covers such topics as the scope and jurisdiction of the RAC program, review criteria, recovery requests, and medical record review.

The guide provides answers to some of the more pressing concerns physicians have about the RAC program. For example, it clarifies that

physicians have the right to appeal an RAC finding of overpayment, just as they can a Medicare contractor's claim denial;
CMS limits the number of records an RAC program contractor may request from a physician or a group practice in a 45-day period, but the limitations vary with the size of the practice; and
there is a limitation on recovery of small overpayments -- RAC program contractors cannot attempt to recoup any overpayment that is less than $10, and claims less than $10 cannot be aggregated.

The online guide also has a section on how physicians can help protect their practices from becoming entangled in RAC recovery efforts.

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